Unlike fracture of the femoral neck, osteoporotic pelvic fractures that do not require procedural intervention may receive scant attention despite significant risks of morbidity and mortality (1-3). Initiation or modification of osteoporotic therapies including calcium, vitamin D and bone remodelling agents, most commonly bisphosphonates, may be neglected in favour of more acute priorities of pain relief and mobilisation. The aim of this study was to determine if patient factors including discharge disposition and mobility were associated with modification to osteoporosis treatment during an admission with pelvic fracture.
We retrospectively reviewed medical records of patients aged 65 years and older who were admitted to the General Medicine Unit between July 2010 and June 2013 for pelvic fracture. Osteoporosis therapy was defined as treatment with calcium, vitamin D and/ or bone remodelling agents. Group A were discharged on no therapy or one medication and Group B were discharged on two or three osteoporosis medications.
158 patients met the inclusion criteria. There were 77 patients in Group A and 81 patients in Group B. Factors such as discharge to high level care or very poor mobility, did not differ between groups (p=0.57 and p=0.08 respectively). There were significantly less patients from Group A on vitamin D (OR 2.27, CI 1.16-4.42, p = 0.016), calcium supplementation (OR 4.72, CI 2.16-10.3, p = 0.009) or bone remodelling agents (OR 2.84, CI 1.3-6.22, p = 0.009) on arrival to hospital. Therefore the most significant determinant of discharge medications was admission medications.
Hospital admission for pelvic fracture does not change osteoporosis treatment in our hospital. Plans for osteoporosis management should be reviewed during discharge planning for all pelvic fracture patients. We plan to assess the effect of management algorithms with check-listing of interventions and follow-up for all elderly fracture patients.